CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Ophthalmology
92012 — Ophthalmological services; established patient, intermediate
This is a follow-up eye exam for an established patient (seen within the past 3 years) that focuses on evaluation and management of a known condition with a limited examination.
- Typical setting: Eye doctor's office
- National avg charge (illustrative): $60–$140 (intermediate established patient eye exam)
- Most-disputed reason: Being billed as a new patient (92002/92004) when you are actually an established patient — verify whether you have seen this provider or anyone in the same practice within the past 3 years.
What it means
What 92012 actually means
This is a follow-up eye exam for an established patient (seen within the past 3 years) that focuses on evaluation and management of a known condition with a limited examination. It is used for routine monitoring or focused problem visits.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Being billed as a new patient (92002/92004) when you are actually an established patient — verify whether you have seen this provider or anyone in the same practice within the past 3 years.
- Billing the intermediate code (92012) when the documentation supports a comprehensive visit (92014) — the comprehensive exam requires broader examination elements.
- Charging for diagnostic tests (fundus photos, visual fields) without separate documentation that those tests were ordered and performed as distinct medically necessary services.
If you see 92012 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 92012 often also see these adjacent codes on the same bill.
CPT
90472 — Immunization admin; each additional vaccine
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90651 — Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90670 — Pneumococcal conjugate vaccine, 13 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90671 — Pneumococcal conjugate vaccine, 15 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90677 — Pneumococcal conjugate vaccine, 20 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
Related BillBusted guides
Plain-English reads if you see 92012 on a bill.
92012 FAQ
Plain-English answers.
What does 92012 usually cost?
$60–$140 (intermediate established patient eye exam). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on 92012?
Being billed as a new patient (92002/92004) when you are actually an established patient — verify whether you have seen this provider or anyone in the same practice within the past 3 years.
What should I do if I see 92012 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to 92012 before paying.
Don't pay 92012 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.